Cough Diseases Flashcards
When a dog presents with a cough, what differentials are more likely for an older dog vs. a younger dog?
Young: infectious
Older: chronic bronchitis, neoplasia, cardiac disease
If an animal is coughing due to CHF, it should be tachycardic. T/F?
True
What easy diagnostic test should be performed on all animals with a chronic cough?
fecal
What is the most common parasite found in the lungs of dogs to cause clinical disease?
Filaroides osleri (canine lungworm)
If a feline presents with a chronic illness, which diagnostic tests should be performed?
FeLV and FIV snap tests
What type of radiograph should be taken to see an intrathoracic collapse? Extrathoracic collapse?
Intra= expiratory film
Extra= inspiratory film
When would performing a transthoracic aspirate be indicated?
diffuse pulmonary disease
solitary lung mass
pneumonia
What is the location used for obtaining a transthoracic aspirate with diffuse disease?
7-9th intercostal spaces
2/3 the distance from the costochondral junction to the spine
What is the most common complication of transthoracic aspirates?
pneumothorax
When is a tracheal wash indicated? When would it not be helpful for diagnosis?
Indicated for airway and diffuse alveolar disease
Not helpful with interstitial and focal disease
For a transtracheal wash, where is the catheter inserted?
cricothyroid ligament
Which procedure requires general anesthesia (TTW) or (Endotracheal wash)?
Endotracheal wash
What is the main purpose of performing a bronchoscopy?
collect samples from the lower respiratory tract
When is BAL indicated?
Diseases affecting the small airways, alveoli, +/- interstitium
Which cell type should predominate on cytological analysis of BAL?
large mononuclear cells
Causes of acute cough?
Most common: Pneumonia & CN Infectious respiratory disease
Pulmonary Thromboembolism (PTE)
Intrathoracic tracheal or bronchial foreign body
Non-cardiogenic pulmonary edema
Eosinophilic bronchopneumopathy
Post-nasal drip Hemorrhage
Congestive Heart failure
T/F Dogs with CN Infectious respiratory disease typically have systemic signs of illness.
FALSE
Does CIRD need to be treated?
Depends on if it’s complicated or not
Uncomplicated- often self-limiting (1-3 weeks) abx not usually needed
Which abx if used are a good first choice for CIRD?
Doxycycline
trimethoprim/sulfas
amoxicillin-clavulanate
Antitussive therapy is contraindicated in dogs with bacterial pneumonia. T/F?
True
What is a good first line choice for bacterial pneumonia in terms of abx? How long should your course be?
Ampicillin, cefazolin, TMS, aminoglycoside
1 week past resolution of clinical signs and rads signs
What virus is most likely to result in pneumonia?
distemper
What is the difference in the type of inflammation seen with bacterial vs. fungal pneumonia?
Bacterial: neutrophilic
Fungal: pyogranulomatous
How long should your course of antifungals be for a fungal pneumonia?
3 months past resolution of clinical signs
What radiographic signs will be evident with aspiration pneumonia?
an alveolar pattern in the R-middle lung lobe
+/- megaesophagus
When would abx be indicated in a patient with aspiration pneumonia?
no improvement after 2-3 days
inflammatory leukogram is getting worse
fever develops
animal has been on H2/PPI
Differentials for chronic cough
collapsing trachea
chronic bronchitis (canines)
Bronchiectasis
Parasites
eosinophilic bronchopneumopathy
Primary ciliary dyskinesis
others (Feline bronchitis/asthma, pulmonary neoplasia, cardiac disease heart enlargement/CHF)
Tracheal collapse results from narrowing of the tracheal lumen from what two processes?
flattening of the cartilaginous rings
redundancy of the dorsal tracheal membrane
Which age and breed of dog are most predisposed to tracheal collapse?
toy breeds
middle age to older
What is the classic sign associated with tracheal collape?
goose honk
When performing radiographs, when will you be able to visualize intra vs. extra-thoracic collapse?
Intrathroacic= expiratory films
Extrathoracic= inspiratory films
A 10-year-old Yorkie presents with tracheal collapse and is in respiratory distress. What is the emergency treatment? Why are opioids often added to the treatment plan?
Oxygen therapy +/- intubation/tracheostomy
Anxiolytic PRN (diazepam/ace) + opioid (butorphanol/hydro)
Anti-inflammatory
What environmental changes can be made to improve tracheal collapse?
weight management
reduce exposure to respiratory irritants (smoke)
minimize exercise
replace collar with harness
What are the two preferred antitussives to use with tracheal collapse?
butorphanol
hydrocodone
How does Lomotil (diphenoxylate hydrochloride and atropine) act to help with medical management for tracheal collapse?
diphenoxylate = acts as opioid antitussive
atropine= reduces the amount of mucus secreted by the lower airways + an antimuscarinic bronchodilator
What two side effects of steroids make their use in cases of tracheal collapse less desirable?
tachypnea
weight gain
When would bronchodilators (methyllxanthines and beta agonists) be considered for use in cases of tracheal collapse?
WITH concurrent small airway disease
What is the salvage procedure performed for tracheal collapse? What are the associated complications?
placement of internal stents for an extrathoracic collapse
infection, stent fracture or migration, obstruction from granulation tissue
What is the most common sign for chronic canine bronchitis?
dry cough exacerbated by exercise/excitement progressively getting worse over weeks-years
Culture (mycoplasma & aerobic) should always be done on chronic canine bronchitis cases. T/F?
TRUE
What treatment is generally most important for reducing clinical signs with CN chronic bronchitis?
Glucocorticoids (prednisone 1 mg/kg for 10 days, then taper 0.5-1 mg/kg q 48hrs)
Why is the treatment for CN chronic bronchitis more focused on reduction of clinical signs rather than a cure?
most of the damage to the lungs is irreversible
What is the MOA for B-agonists in acting as a bronchodilator to help with canine chronic bronchitis?
relaxation of bronchial smooth muscle
increased mucociliary transport rates
stabilization of mast cell membranes
reduction in vascular permeability
When are bronchodilators indicated in a dog with chronic bronchitis?
exercise intolerance or wheezing
A canine presents with chronic bronchitis and is wheezing constantly the owner reports. What would be your treatment plan?
Glucocorticoids (Pred 1 mg/kg then taper)
Bronchodilator (tertbutaline 1 mg/kg BID/albuterol 0.02 BID mg/kg 5 days, then 0.05 mg/kg if no improvement, d/c after 2 weeks no improvement or methlxanthines can be used)
A Golden Retriever with chronic bronchitis was given a bronchodilator. What are the side effects of B-agonists and methylxanthines that you would expect?
Both restlessness
B-agonists: skeletal muscle tremors
What would be indications for use of abx in canine chronic bronchitis?
Evidence of bronchiectasis in a newly dx animal
Acute exacerbation of signs
What # of bacterial colony count are significant and would indicate abx use in cases of CN chronic bronchitis?
1 x 10^4 organisms/mL
A 8 year old beagle with chronic bronchitis has a dry, non-productive cough that keeps both the dog and owner up at night. What treatment is an option for this dog? What is the most common side effect?
Cough suppressant:
Hydrocodone bitartrate (0.22 mg/kg 2-4x/day)
Side effects: drowsiness & constipation
What is the major benefit to administering inhaled steroids (e.g. fluticasone and beclamethasone) vs. oral steroids?
Less systemic effects of steroids
In general what the treatment options for canine chronic bronchitis?
Glucocorticoids
Bronchodilators w/ EI or wheezing
Abx w/ significant culture
Cough suppressants when dry, nonproductive & disruptive
Define Bronchiectasis
permanent dilation of the bronchi
What is often indicated in the treatment of bronchiectasis?
antibiotics b/c susceptible to infection
What are the primary parasites of the lungs?
Oslerus (Filaroides) osleri
Paragonimus kellicotti
Aelurostrongylus abstrusus
In which species of parasites are larval migrans through the lungs common?
Toxocara spp
Ancylostomum
Strongyloides
What is the cause of eosinophilic bronchopneumopathy?
Idiopathic
What is the most common clinical sign of EBP and what age are the dogs with this condition typically?
A cough is the most common clinical sign, occurring in the majority of dogs (4-6 yrs, young adults). The cough is usually harsh and sonorous, persistent, and frequently followed by gagging and retching
What are the rule outs often associated with EBP?
heartworm dz
parasites
lymphoma
What pattern is often seen with EBP?
bronchointerstitial
On a BAL from a dog you suspect to have EBP, what would be a supportive finding?
increase in the total number of cells in the fluid as increase in the percentage of eosinophils (up to 25%) and neutrophils
What is the treatment for EBP?
STEROIDS
What is the congenital defect associated with Primary Ciliary Dyskinesis? Which age & breed of dog are over-represented?
congenital defect/s in the ciliary microtubule structure
< 2 year old
English Pointers and Springer spaniels
A 1 year old dog presents for recurrent respiratory infections. What is a key differential to have on your list? What is the prognosis?
Primary ciliary dyskinesis
Poor
A young dog with primary ciliary dyskinesis often also has what other concurrent conditions?
Infertile (cilia of sperm/fallopian tubes does not fxn properly)
Otitis externa
What differentials are common for acute cough?
Tracheitis/tracheobronchitis
pneumonia, PTE
Parasites (or chronic)
CHF
What differentials are common for chronic cough?
tracheitis/tracheobronchitis
Bronchitis
asthma
bronchiectasis
parasites
atrial enlargement/pulmonary hypertension
